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Primary school children’s experiences of school-based violence and perceptions of child-led child protection committees in Zimbabwe
Get PDFGlobally, children experience multiple forms of violence, including school violence, which includes bullying and corporal punishment. However, schools also hold potential to tackle violence, including through child-led child protection committees (CPCs). This study explored children’s perspectives on school violence, safety and their attitudes towards CPCs in Zimbabwe. We conducted 2 FGDs with 6 boys and 6 girls who were CPC members and 4 participatory ‘round robin’ workshops with 27 boys and 20 girls. Children cited various forms of school violence, holding mixed views on the acceptability of corporal punishment. For children, bullying appears to be the overarching concern. CPCs give some students a sense of authority, but the role and scope of CPC members is not well understood among children. Our study finds that despite legislative changes, acceptability of corporal punishment is still present among children in Zimbabwean primary schools. Bullying remains a key concern of children. We contribute new insights on the potential of CPCs to address forms of school violence such as bullying, however suggest there is a need to clarify the role of CPCs in intervening in violence
Characterizing the quick-killing mechanism of action of azithromycin analogs against malaria parasites.
Get PDFDrug resistance is steadily undermining the efficacy of frontline anti-malarials, highlighting the urgent need for novel therapies with alternative mechanisms of action. The chemical addition of different moieties to azithromycin yields compounds with improved quick-killing potency against malaria parasites, with the most active analogs typically containing a chloroquinoline group. Here, we investigated the quick-killing mechanism of five azithromycin analogs, two of which contain differentially oriented chloroquinoline moieties. The improvement in quick-killing activity over azithromycin for non-chloroquinoline analogs was around 10 -to 42-fold, with chloroquinoline-containing analogs showing a further 2- to 17-fold improvement over non-chloroquinoline compounds. Chemical inhibition of hemoglobin digestion and chloroquine's inhibitory effect against heme polymerization linked analogs with both chloroquinoline and non-chloroquinoline modifications to a chloroquine-like mechanism of action. However, none of the analogs showed a significant reduction in efficacy against chloroquine-resistant asexual blood-stage parasites. Multiple attempts at selecting for azithromycin analog-resistant parasites to elucidate the mechanism of quick-killing were unsuccessful. Application of cellular thermal shift proteomics revealed that azithromycin analogs significantly stabilized 34-155 different proteins in trophozoites, a high number that showed minimal overlap with chloroquine. Additionally, our most potent chloroquinoline-containing analog demonstrated a significant improvement in gametocytocidal activity over azithromycin and further maintained moderate inhibition of chloroquine-insensitive late-stage gametocytes. These findings support that this class of azithromycin analogs kills malaria parasites through a broad range of potential mechanisms, making them promising candidates for optimization as fast and broad-acting anti-malarials
Forecasting the spatial spread of an Ebola epidemic in real time: Comparing predictions of mathematical models and experts
Get PDFBackground:
Ebola virus disease outbreaks can often be controlled, but require rapid response efforts frequently with profound operational complexities. Mathematical models can be used to support response planning, but it is unclear if models improve the prior understanding of experts.
Methods:
We performed repeated surveys of Ebola response experts during an outbreak. From each expert, we elicited the probability of cases exceeding four thresholds between 2 and 20 cases in a set of small geographical areas in the following calendar month. We compared the predictive performance of these forecasts to those of two mathematical models with different spatial interaction components.
Results:
An ensemble combining the forecasts of all experts performed similarly to the two models. Experts showed stronger bias than models forecasting two-case threshold exceedance. Experts and models both performed better when predicting exceedance of higher thresholds. The models also tended to be better at risk-ranking areas than experts.
Conclusions:
Our results support the use of models in outbreak contexts, offering a convenient and scalable route to a quantified situational awareness, which can provide confidence in or to call into question existing advice of experts. There could be value in combining expert opinion and modelled forecasts to support the response to future outbreaks.
Funding:
This study was partly funded by the Department of Health and Social Care using UK Aid funding 47 and is managed by the National Institute for Health and Care Research (VEEPED: PR-OD-1017- 48 20002; AR and WJE). This study was partly funded by the Wellcome Trust (210758/Z/18/Z : JDM 49 and SF). The views expressed in this publication are those of the authors and not necessarily 50 those of the funders
Quantifying maternal vaccination opportunities across gestational age windows: a real-world multi-country, longitudinal study.
Get PDFBACKGROUND: Maternal vaccination is a recognized strategy for reducing maternal and neonatal morbidity and mortality, including in low- and middle-income countries (LMICs). As new vaccines such as those for respiratory syncytial virus (RSV) and group B streptococcus (GBS) will be administered according to gestational age (GA), understanding real-world patterns of contact of pregnant women with antenatal care services (ANC) across pregnancy is essential to inform the most effective delivery strategies.
METHODS: We conducted a retrospective longitudinal, multisite analysis using anonymized data extracted from maternal health registers at ANC and delivery clinics in 6 LMICs: Bangladesh, The Gambia, Nepal, Nigeria, Tanzania, and Uganda. Eligible clinics contributed data from ANC and delivery services and access to routine data from January 2019 to December 2022. Retrospective, individual-level ANC attendance data from a total of 123,867 individuals were included in the study. These included the total number of ANC attendances per woman and GA at first and last ANC contact. The GA determination practices of each clinic were also recorded.
RESULTS: Across all sites, women had a median of 4 ANC contacts per pregnancy (IQR 2-5). An estimated 79·2% of women had at least one ANC contact during the 24-36-week GA window, falling to 66·6% in a 28-36 week GA window, and 46·5% at 32-36 weeks. When stratified by ANC contact frequency, the proportion with at least one contact in 24-36 weeks increased to 94·1% among women with ≥4 ANC contacts, indicating significantly greater vaccine delivery potential among those with more frequent ANC contacts.
CONCLUSION: In these LMIC settings, the 24-36-week GA window presents opportunity for delivering maternal vaccination at high coverage. These findings underscore the need to align maternal vaccine delivery strategies with real-world ANC patterns to ensure equitable and timely vaccine access in LMICs
Setting-driven design: a context-driven approach to behavioural design
Get PDFThis paper introduces Setting-Driven Design (SDD) and supporting tool – the Behaviour Setting Canvas (BSC) – which together address a critical gap in behavioural design by shifting the focus from individual behaviour to the broader context in which behaviour occurs. Rooted in behaviour setting theory, SDD is a powerful approach to behavioural design that offers an end-to-end structure for understanding and intervening in a behavioural design challenge. The process comprises three iterative phases: scoping the behavioural challenge, understanding the setting and intervention development. The process structure revolves around the BSC, a tool for mapping key contextual elements such as roles, motives, norms and routines. While SDD is particularly effective for behaviour change interventions, its utility extends to other design challenges, including introducing new products, shifting social norms and enhancing existing systems where behaviour remains constant. The approach integrates a theory of change to guide intervention development, prototyping and evaluation, ensuring alignment with behavioural objectives and contextual realities. A case study on handwashing in low-income Tanzanian households illustrates the method’s utility, culminating in the creation of Tab Soap, a single-use, biodegradable soap designed to improve hygiene behaviours. The study demonstrates how SDD facilitates insight generation and iterative refinement and complements user-centred design. SDD advances behavioural design by combining theoretical rigour with practical application, offering a scalable and adaptable framework for addressing complex design challenges across diverse fields
How Does Experience of Violence in Childhood Affect Work Outcomes? A Systematic Review of Longitudinal Studies.
No full textExperiencing violence in childhood and adolescence is both common and long-lasting, and associated with poor short- and long-term health and economic outcomes. In the current study, we reviewed evidence from longitudinal studies on the association between violence in childhood and work outcomes to determine the direction and magnitude of the association, explore variations by violence type, identify evidence gaps, and describe the extent of research and findings on mediators. We systematically searched nine databases for longitudinal studies reporting on the association between violence in childhood and work outcomes, and conducted a narrative synthesis. We identified 46 reports of 27 cohorts, with all but one cohort from high-income countries. This review shows that there is strong evidence from high-income countries that violence in childhood is associated with a range of negative work outcomes. Evidence is strongest for official reports of child abuse and neglect, physical violence, bullying, and composite violence measures, but is more mixed for sexual violence. There is less evidence for emotional violence, witnessing violence, neglect, and adolescent intimate partner violence. Associations are similar for men and women. Nine reports conducted mediation analyses, mainly examining educational factors as mediators. Evidence suggests that educational factors may partially mediate the relationship between violence and negative work outcomes. Cognition, mental health, and noncognitive skills may also be mediators. There is a need for data from low- and middle-income countries, and further mediation analyses to help guide efforts to reduce negative consequences of violence
Evidenz‐ und konsensbasierte (S3) Leitlinie: Management der Urethritis bei männlichen* Jugendlichen und Erwachsenen
Get PDFZusammenfassung
Die Urethritis ist ein häufiges, überwiegend durch sexuell übertragene Erreger wie Chlamydia trachomatis, Neisseria gonorrhoeae oder Mycoplasma genitalium verursachtes Krankheitsbild. Alleine aufgrund klinischer Merkmale ist die Unterscheidung der Erreger und der Ausschluss von Koinfektionen nicht sicher möglich. In der praktischen Versorgungssituation wird jedoch oftmals, noch vor dem Erregernachweis, eine empirische antibiotische Therapie durchgeführt. Ziel dieser evidenzbasierten S3‐Leitline ist die Förderung einer rationalen Syndrom‐orientierten Herangehensweise an das klinische Management männlicher Jugendlicher und Erwachsener mit Symptomen einer Urethritis.
Neben Empfehlungen für Diagnostik, Klassifikation und Therapie beinhaltet die Leitlinie Empfehlungen zur Indikationsstellung für die empirische antibiotische Behandlung der penilen Urethritis. Neu gegenüber vorbestehenden, erregerspezifischen Leitlinien ist unter anderem das Flowchart für das Syndrom‐orientierte praktische Management. Bei Indikation zur empirischen Behandlung und Verdacht auf eine gonorrhoische Urethritis soll Ceftriaxon angewandt werden. Zusätzlich sollte, aufgrund des Risikos für eine Koinfektion mit Chlamydia trachomatis, Doxycyclin verordnet werden, es sei denn, eine Wiedervorstellung zur Behandlung möglicher Koinfektionen ist gesichert. Bei Verdachtsdiagnose einer nichtgonorrhoischen Urethritis soll die empirische Therapie mit Doxycyclin erfolgen. Azithromycin ist zur empirischen Behandlung der gonorrhoischen und nichtgonorrhoischen penilen Urethritis nur einzusetzen, wenn Kontraindikationen gegenüber Doxycyclin bestehen. Detaillierte Empfehlungen zur Differenzialdiagnostik, erregerspezifischen Behandlungen, spezifischen Situationen und zur Beratung und Nachsorge finden sich in der Leitlinie
Methods used in early value assessments for nice: a scoping review.
Get PDFObjectives: The National Institute for Health and Care Excellence (NICE) in England introduced early value assessments (EVAs) as an evidence-based method of accelerating access to promising health technologies that could address unmet needs and contribute to the National Health Service's Long Term Plan. However, there are currently no published works considering differences and commonalities in methods used between Assessment Reports for EVAs.
Objectives
The National Institute for Health and Care Excellence (NICE) in England introduced early value assessments (EVAs) as an evidence-based method of accelerating access to promising health technologies that could address unmet needs and contribute to the National Health Service’s Long Term Plan. However, there are currently no published works considering differences and commonalities in methods used between Assessment Reports for EVAs.
Methods
This rapid scoping review included all completed EVAs published on the NICE website up to 23 July 2024. One reviewer screened potentially relevant records for eligibility, checked by a second reviewer. Pairs of independent reviewers extracted information on the methods used in included EVAs using a prepiloted form; these were checked for accuracy. Data were described in graphical or tabular format with an accompanying narrative summary.
Results
In total, seventeen EVA Reports of sixteen EVAs were included in this scoping review. Five Reports did not specify how many reviewers undertook screening, whereas five did not report data extraction methods. Five EVAs planned to conduct meta-analyses, nine planned narrative syntheses, and seven planned narrative summaries. Eleven conceptual decision models were presented, with available evidence used to construct cost-utility analyses (N = 5); cost-effectiveness analyses (CEAs; N = 4); a mix of CEAs and cost-consequence analyses (CCA; N = 2); one CCA; and one cost-comparison.
Conclusion
Future EVA Reports should enhance the transparency of the methods used. Furthermore, EVAs could provide opportunities for the adoption of innovative methodological approaches and more flexible communication between EVA authors and key stakeholders, including patients and clinicians, companies, and NICE
Risk factors for scrub typhus infection in South India: population-based cohort study.
Get PDFScrub typhus is a mite-borne infection, largely affecting rural populations in many parts of Asia. This cohort study explored socio-demographic, behavioural, and spatial risk factors at different levels of endemicity. 2206 rural residents from 37 villages in Tamil Nadu, South India, underwent a questionnaire survey and blood sampling at baseline and annually over 2 years to detect sero-conversion. Satellite images were used for visual land use classification. Local sero-prevalence was estimated using 5602 baseline blood samples.Two hundred and seventy cases of seroconversions occurred during 3629 person-years (incidence rate 78/1000, 95%CI 67, 91). Older age was associated with scrub typhus in crude but not in multivariable analysis adjusting for socio-economic factors. By contrast, the increased risk in females compared to males (RR 1.4) was unaffected by adjusting for confounders. In multivariable analysis, agricultural and related outdoor activities were only weakly associated with scrub typhus. However, agricultural activities were strongly associated with scrub typhus if local sero-prevalence was low, but not if it was high. Females were at a higher risk than males in high-prevalence areas but not in low-prevalence areas. To conclude, agricultural activities were not strongly associated with scrub typhus. Transmission within human settlements may predominate in highly endemic settings
Housing modification to prevent malaria in Uganda: an analysis of costs, willingness to pay, and equity.
Get PDFBACKGROUND: Innovative, equitable, and sustainable multisectoral solutions are required to address persistently high global malaria deaths, widespread insecticide and antimalarial resistance, and falling funding for malaria control. Housing modification presents a promising option. Alongside a cluster-randomized control trial in Eastern Region, Uganda, we analysed the costs and households' willingness to pay (WTP) for two housing modification interventions, screening and eave tubes, focusing on equity and scale-up potential.
METHODS: Taking a disaggregated societal perspective, we assessed financial and economic costs of installing two housing modification interventions in approximately 4000 homes (20000 people). We collected WTP data through three cross-sectional household surveys (n = 1500 households each) using modified structured haggling and calculated price elasticity of demand. We used multivariable regressions and concentration indices to analyse how costs and WTP varied by household characteristics. To identify potential financing gaps, we compared WTP to costs and examined variation by household wealth quintiles.
RESULTS: Screening cost a mean of 112-120) United States Dollars (2022 USD) per house; eave tubes cost 48-52). When annualized over 5 years, screening cost 3.03. Installation cost more in the wealthiest versus poorest quintiles for both screening (69) and eave tubes (31). Over 75% of respondents were willing to pay something for the interventions, but these values represented only a small fraction of the costs, with a higher fraction in the wealthiest vs poorest quintiles (screening: 12% vs 7%; eave tubes: 18% vs 14%).
CONCLUSIONS: While housing modification has relatively high upfront costs, its annual cost per person protected is comparable to other malaria interventions. Households, especially the poorest, are unwilling or unable to pay the full cost of housing modifications. Equitable scale-up would require additional financing and/or demand-boosting interventions.
TRIAL REGISTRATION: NCT04622241 (clinicaltrials.gov)